Book reviews

For years, the only publicly available description of the Unix operating system was the Lyon's Book, produced by the University of New South Wales. It contained a complete listing of the Unix source code plus a line-by-line commentary, and it was available to people without source licenses. Unfortunately, it only described Version 6 Unix, which by now is at least four versions out of date. Those of us who were lucky enough to have source licenses were at least able to see the source code, but it was not very understandable in the absence of a commentary. Maurice Bach has written a book that at least alleviates our problems. Based on a course that he taught at AT&T Bell Laboratories in 1983 and 1984, the book is designed as a companion to the source code. The book explains the algorithms involved inside the kernel rather that providing a line-by-line commentary on the code. It is up-to-date in that it describes Unix System V Release 2, which is the most common AT&T variant of Unix used today. To add generality to the book, Bach also covers some features from Unix System V Release 3 and from the Berkeley Software Distributions (BSD) versions of Unix. The book is a treasure trove of information. The first chapter consists of an overview of the Unix system for those people who are not familiar with it. The next chapter previews the rest of the book by describing first the structure of the kernel and then the process subsystem and the file subsystem. The rest of the book is divided into three sections. The first one is devoted to the file subsystem, with chapters on the buffer cache, the representation of files and the system call interface to the file system. The next section covers the process subsystem, including memory management, interprocess communications and the I/O subsystem. (A discussion of the I/O subsystem appears here instead of in the file subsystem section, where it might more logically belong. This arrangement allows Bach to discuss the issues of process control that accompany the writing of terminal drivers.) The final two chapters cover advanced topics-multiprocessor Unix systems and distributed Unix systems. Before reading the book seriously, I skimmed it to try to get a feel for it. I found the presentation very pleasing. Bach has broken out the algorithms and presents them in a very readable pseudocode. He provides a lot of pictures describing how data structures fit together. At this first glance, the book seemed very readable. I was not disappointed. After glancing over the table of contents, I wanted to see how good the coverage of the particular topics is. I have spent a lot of time writing device drivers and protocols, usually implemented as line disciplines, at least since the advent of System III. Unfortunately, none of the information that accompanied the release of System III said anything about the line disciplines other than that the entries for the routines belonged in the linesw table. Turning to the section on terminal drivers, the first thing that I saw was a bullet list of seven items describing what a line discipline had to accomplish. Here, already, was more documentation than AT&T had provided on the topic. The description is clear and succinct. It includes a step-by-step description of how to put characters on and take them off clists. For anyone who has ever spent time figuring out exactly how to manipulate all the pointers and counts, it's nice to see this procedure written down clearly. From line disciplines, I went to an area that I was not so familiar withstreams. Streams are a new feature in System V, release 3 that were designed by Dennis Ritchie to provide more flexibility and modularity in the I/O subsystem. Bach provides a good description of what streams are and how they are intended to be used. He also provides a high-level description of how to use streams to implement windows on a terminal. This description draws on a paper that Pike wrote describing the Blit terminal. Bach concludes the section on streams with a discussion of why Ritchie implemented them the way that he did. In this discussion, he identifies some of the remaining shortcomings of the current implementation. Bach's chapter on interprocess communications covers three distinct areas. The first is the use of the ptrace systemn call as a form of interprocess communications for debugging. He then discusses all of the System V IPC mechanisms, message queues, shared memory and semaphores as a group, due to their great similarity in interface. Lastly, he talks about network communications by concentrating on the Berkeley socket implementation. The list of topics discussed can go on and on. As I stated earlier, the book is a real storehouse of information on Unix in particular and operating systems in general. Bach has culled out the essential pieces of Unix by describing the algorithms and data structures in a pseudocode that is easy to understand. He presents a very balanced view of Unix, often describing the shortcomings of the various features he discusses. This book belongs on the shelf of everyone who is involved with the Unix operating system on a regular basis. Having it, you will have a much better understanding of how the system works, and therefore, how to make better use of the system. It is also useful for anyone who wants to know about operating systems. While designed solely for a course on Unix, it describes the major functions and features of operating systems, so that it could also be used for a general operating systems course. The only complaint I have, and considering the purpose of the book it may not be a valid one, is the lack of discussion of Berkeley extensions to the Unix system. Berkeley has made extensions to Unix in three areas: the fast file system, the terminal handlers in the line discipline area, and the use of sockets for network communications. Of the three, only the last is covered to any extent. It would have been nice if the book covered the other two topics in the appropriate chapters, since no easily readable discussion of them is available anywhere.

HEREDITARY diseases are a fruitful source of terror to the patient, and of inquiry to the physician. One should therefore have expected that before this time the subject would have been generally understood, or at least accurately canvassed. Yet, if we may believe our author, no systematic inquiry on the subject has been instituted from the day's of Mercatus, who wrote at the beginning of the seventeenth century, till our own times, a period of nearly two hundred years. When the Memoirs of the French National Institute presented us with M. Portal's paper,* on account of the celebrity of the author, as well as the novelty of the inquiry, we thought it right to make our readers acquainted with that essay ; and, if its appearance has given rise to the pre,, sent performance, we shall think our time and labour amply repaid.
The work commences with a distinction between hereditary aid family diseases'; the former are such as are transmitted from parents to their offspring, the latter such as appear in more than one of the offspring of parents free from such complaints. These distinctions are carefully kept in view throughout, and by attending to them an inference is * For a translation of M. Portal's paper, extracted from the French Natimal Institute, see Med. and Phys. Journal,vol. xxxi. p. 229,and 281. drawn Dr. Adams on the Hereditary Properties of Diseases. 141 drawn, that connate diseases or privations of senses arc rarely, if ever, hereditary, but often appear among brothers and sisters, the offspring of parents free from such inconveniences.
The different periods of life at which such diseases show themselves, forms the next division ; and on these the prognosis of the access, and even cure of such complaints, are made very much to depend. As the deductions are drawn from a great number of observations, collected with much industry, we shall not offer any opinion upon them, but in our short analysis at once introduce our readers to the last and most important part of the inquiry, namely, " what provision is made by Nature to correct the influence of such hereditary causes, and how far they can be imitated and improved by art?" These provisions are pointed out in the influence produced by climate, in the result of customs during the less cultivated state of society, and also in the progress of refinement; and lastly, in the positive laws, human and divine, which seem to have had such a provision in view. That these provisions are sufficient, in almost every case, is shown by the present state of mankind, and by the necessary consequence that would have followed the want of them. This is most strikingly illustrated in a single instance, in which none of these could avail, because the cause would be constantly operating; and here a special provision is made by an effect of the disease itself, which entirely supersedes propagation from such sources. < " But should there exist a disease, (says our author,) the disposition to which is excited by climate; should such a disposition become hereditary, and should the disease when excited prove incurable, from such a combination of causes we could expect nothing less, than the gradual extinction of the race; and should the district be repeopled, the same succession of causes and effects must gradually extinguish the descendants of the new Colonists; yet, such a disease does exist in the finest and most extensive part of the habitable globe.
Human institutions have indeed made some feeble attempt at restraining it, but human endeavours must have proved ineffectual. Happily, the same power which permitted such a cause, has fixed limits to its effects. < " The Elephantiasis of Aretasus is peculiar to warm climates 5 the disposition to the disease is hereditary, and the disease itself has, hi-Iherto, proved incurable. I have never been able to learn, that it lias attacked emigrants from a colder climate, nor their immediate descendants. A residence therefore of some generations, is probably necessary to induce the disposition. When this diseased disposition is derived from inheritance, the action always commences before the Ege of puberty ; and the subject never arrives at that state ; the organs are never evolved, and ho other marks of virility appear. When Critical Analysis. the disease originates with an individual, it usually commences a( a more advanced age; but from that time, the organs which distinguish the sexes decay, and become gradually unfit for their original purposes. The fact of a disease, which arrests the progress to virility of every )Outh, and emasculates every adult whom it attacks, is so surprising, that after having witnessed it myself, I should have been backward in publishing the result of my observations, had not others been present at every examination ; and I should have been unwilling to draw inferences from them, had not subsequent writers confirmed my account.* " Thus an hereditary disposition to an irregularity of the most formidable nature, which being excited by climate, must have progressively increased in spite of all human institutions, is arrested as soon as it occurs, by those very actions which form a part of the deviation from the usual progress of Nature.'1 Such is the short analysis our limits will afford of this interesting work. A great number of notes are added, which snay be said to form distinct essays. We shall particularly siotice one as connected with that peculiar property of Elephantiasis, to which our extract refers. The author seems fearful lest a passage in Dr. Bateman's Synopsis should seem to invalidate his testimony on a fact to which he attaches so important a final intention. Without entering into the controversy we shall briefly state its outlines. A ret a: us is the ?first writer from whom we can collect any accurate description of Elephantiasis. Among the symptoms, he mentions libido ine.vplchilis, in which he has been followed or at least uncontradicted by every subsequent, author till Dr. Adams.
We need not say how much the symptom described by him is at variance with the salacious temper imputed to these unhappy objects, nor need we enter into any speculations on Its existence after the notice given in our former Number of the case now in St. Bartholomew's Hospital, which any of our readers may examine.
The passage concerning the Itch, its true diagnosis, and the various eruptions confounded under the same name, is not the least interesting, nor by any means the least important part of the work; whether we consider the frequency of the disease, or how little it is understood by those whose practice is confincd to the higher ranks. It also gives Dr.
Adams an opportunity of descanting on one part of tiie study of medicine, the influence of which is become so extensive. that, if ill directed, it must prove highly injurious to mankind,, in a science so necessary to its comfort as the treatment of disease; for it cannot be necessary to acid, that the slightest misnomer may introduce a fatal error into practice. U we understand our author, this is the object he* has in view inobjecting to the word Typhus, which he seems to hint has been the source of an error in the army practice, which is now pretty generally admitted. The passage is so pointed that we shall make no apology for transcribing it. " These remarks on names, somewhat abruptly introduced, ma? serve to show how careful we should be in changing commonly-received terms. Whether we use psora or scabies lor itch, may seem of little consequence, as it is not certain that those from whom we derive the words were acquainted with the disease to which we now apply them. But whenever a name is changed; some regard should be paid to etymology, as the great use of nosology is, that we should all be acquainted with each other's language. If we expect more than this, there will be great danger of misleading ourselves. The first person who proposed an arrangement of diseases, similar to what is made of plants, was Sydenham. He, however, rather looked to it with a wish than an expectation of its accomplishment, and seems not aware that the arrangements of botanists were, in many instances,-artificial, It is certain, that he lived to lament the application of practice to names, declaring, in the most advanced period of his practice, (hat * the invention of the term, or opinion of malignity, had been far more destructive to mankind than the invention of gunpowder.' I leave it to the decision of those who have had most experience, in the comparative effects of disease and gunpowder, how far the introduction of the term Typhus may be liable to a similar charge. We may at least remark, that the very fever which drew this expression from Sydenham, is, by Dr. Cullen, included among the Synonyma of Typhus.* As the illustrious Professor refers to every original author, it would be unreasonable to accuse him, if such sources of information are not studied by his readers; and if he made his Nosology a textbook for his lectures, we cannot doubt that his hearers were often apprised, that the same mode of practice could not be applicable to fevers arising from so many causes, assuming so many forms, appearing in such different climates, and under habits of life so different as to comprehend near fifty synonyms. Still, we may lament the influence of a term, in a work which, from the just celebrity of thewriter, and its connection with the ' First Lines,' may hereafter become the text-book of less enlightened lecturers, as it is already of physical compendiums. " Diseases of the skin being more immediately the objects of our senses, may be thought more easily reducible to orders and genera.
Let us try this in Itch and Syphilis; because, in these we are most frequently required to give a decided opinion. Of the first, if "* " Febris nova anni, 1685, Syden, Scedul. Monitoria. enough 141 Critical Analysis. enough has not been said,: to show the difficulty which attends sact/ sin attempt, we may add from the Synopsis, that 'from its affinity with three orders of eruptivfe appearances, pustules, vcsicles, and papulae, it almost bids defiance to an artificial classification.' The above orders, comprehending only fifteen genera with their specie.? and varieties, may be less alarming to a modest enquirer. But the eruptions of Syphilis are said to ' bid defiance to arrangement, according to external character;' that, ' in fact, they possess no common or exclusive marks, by which their nature and origin are indicated ;' and that ' there is no order of cutaneous appearances, and scarcely any genus or species of chronic, eruption already described, [ cessful in Scarlatina. * Though in the treatment of these diseases^ improvements may be expected, and changes necessary under different circumstances, yet the phenomena of the diseases themselves4 as marked by those writers, are now so familiar to us all, as to admit of no dispute. It this can be accomplished in fevers, shall we despaif of arriving at the same certainty in diseases, whose progress 13 slower ? It must be admitted, that for so desirable an event, we require the same talent at observation, the same persevering diligence, with the .same integrity as existed in the man who, after establishing such laws, should declare that there are small-pox cases, which the errors of a nurse could not render fatal ; and others, which the skill of no physician could cure. When, therefore, we possess the fruits of such men's labours let us learn how to value them.

"
Having made these general remarks, I shall trace very shortly the progress of Mr. Hunter's inquiries, in a disease which is said ' to possess no common or exclusive marks.'" Dr. Adams proceeds to trace the very confused history given of venereal complaints before Mr. Hunter's time, and the greater accuracy which his discrimination has introduced! Tiiis he proves in a most striking manner by the controversy which at one time existed as to the importation of that disease into Otaheite, two nations mutually accusing each othei4 as the authors of .an event which there is reason to believenever existed. We should dwell longer on this and several other passages, were it not that from what we have already produced, and from the well-known character of the author,, we cannot doubt that the work will be in the possession of most of our readers. about a year and a half since, and again in the coarse of four or live months; but for the last two or three periods, nearly at the end of five weeks. The discharge exactly resembled that of most women, except that it was of rather a darker colour. The last period was about the 5th of March, 1S1 3, when the girl looked pale, and seemed vo* 186. V iC 146 Critical Analysis.

Medico-Chirurglcal
to have a degree of lassitude about her. The breasts are Very full, and as large as most young women's of twenty years of age. She is very broad over her chest and loin*. Her pelvis seems much larger than is e^er observed at her age. The pubes is covered with a whitecoloured hair, which began to shew itself when she had the first appearance of the catamenia. She is quite a little woman in her appearance, except as to her countenance, which is childish. She is much bigger than a sister who is two years older. She plays with children of her own age, and does not seem to have any sexual feelings, or an uncommon degree of modesty. That there might be no mistake with respect to her age, the register of the parish where she was baptised was examined, which specified her being born on the the rigidity of the wrist was so great, that had not my patient possessed an uncommon share of courage, she must have been disheartened from any further attempt. By the use, however, of warm water, and embrocating the parts with oil, it gradually gave way, in the course of about ten weeks, to a moderate degree of force applied by my hand daily." The author derived advantage from an apparatus which he contrived of a spring made of iron, which projected from the back part of the wrist over the back of the hand. To this a piece of soft leather, passed round the inside of the fingers and palm of the hand, was fixed, and thus the hand was effectually kept in its situation. XV. History and Dissection of a fatal Case of Cyhanche Laryngca. By Edward Percival, M.D. Dublin. This case is so highly interesting, both from the style in which it is narrated, the peculiar circumstances which .attended it, its termination, and the scope which it affords for reflection, that we shall present it to our readers as communicated by the learned author. " The following recital of a case of cynanche laryngea, whose fatal event has lately deprived the world of an eminent character, is transcribed from notes taken daily during my personal attendance upon him, in conjunction with another physician and two surgeons. " X. Y., aged 63, of spare, though muscular habit, and somewhat delicate health, was attacked with apparently slight catarrh and sore throat, in consequence of a hasty and fatiguing journey. On Tuesday, May the 4th, 1813, he consulted an eminent physician of this eity, who advised purgative and sudorific remedies, under which treatment the symptoms appeared wholly to subside. Having imprudently ridden out, and exposed himself to a cold east wind, the catarrhal affection recurred on Friday the 7th, when he was directed to be bled to the amount of 16 ounces, to take a pill of calomel and cathartic extract, and a draught with nitre. He rested perfectly well this night, and appeared nearly in his usual health on the following morning. His tongue was clean, his pulse between 70 and 80 strokes in the minute; and he took an airing in his carriage in the course of the day. On the following morning (Monday) he again manifested catarrhal symptoms, with sore throat, and hoarseness. He Critical Analysis.
Was now directed lo lake James's powder to some extent, which in* duced profuse perspiration, with great relief of all the urgent symptoms. Before the sweating had subsided, on Tuesday morning, he injudiciously rose from his bed, and occupied himself during the day, by dictating aloud to some attornies in his chamber. In the evening, his respiration became much impeded, and his voice extremely hoarse; which alarmed him by the resemblance of the present attack, to one which he experienced in London, eleven years before. On that occasion, he was bled copiously and repeatedly, and narrowly preserved his life. The patient himself, and several of his friends, affirmed the disorder to he the same as the present, and confined to the upper parts of the windpipe. It may be proper to observe, that his father suffered a severe attack of this kind many years ago. " On Wednesday morning, I saw him for the first time, in conjunction with another physician and a surgeon. His countenance was then pale and anxious; his eyes protruding ; his tongue foul and much swelled ; his respiration slow and laborious, with a shrill or Stridulous sound, as of air forcibly passing through a narrow orifice; and his voice indistinctly audible, in the lone of a hoarse whisper. He had a perpetual inclination to expectorate; but ail his efforts to this purpose were fruitless, which added much to his distress, by the continual apprehension of suffocation. He was perfectly unahle to swallow any substance, whether fluid or solid, as the smallest portions of either were instantly rejected with violent coughing. The visible internal fauces were of natural appearance and pale colour.
He informed us that he had experienced some shooting pains about the larynx, which were now entirely subsided. The epiglottis was Swollen or distended, and somewhat erect; vyhich acc ounted lor the coughing and sense of suffocation on attempting to swallow any-lhing, as this organ had ceased to act as a valve upon the larynx. His jpulse Was full, throbbing, and very frequent.
'f Twenty ounces of blood were withdrawn from his ^rm bv a, large'orifice, which afforded some immediate relief lo his respiration and his general feelings of distress. He now thought he was able to swallow, but, on attempting it with a tea-spoonful of water, the fluid was rejected with a fit of cqughing, or rather of suffocation, which hearly extinguished life. " Sixteen leeches were now applied to his throat, and two purgative enemata were administered, which brought away no faeces. " In the afternoon, his urgent symptoms appeared to be stationary, twelve ounces of blood were taken from his arm, and a dozen leeches applied lo his'throat.
. f? At nine o'clock, p. m. his pulse was softer and less frequent, but his tongue was still swelled and dry, his breathing not amended, 5ind the stridulous sound unabated. Bronchotoipy was now determined upon; and the operation was performed without delay, by a vertical division of the integuments covering the interval between the cricoid and thyroid cartilages; the tracheal membrane was pierced laterally, and a canula was inserted, whose diameter was somewhat less than half an inch? The loss of'blood by this operation might be 149 about six ounces; some part of which escaped into the trachea, and was returned through the aperlure with much gurgling noise. He likewise expectorated a small quantity of mucus. In about half an hour, he breathed with perfect facility, and fully inflated his lungs, which was hailed as a favourable circumstance. He slept at intert vals during the night, for the space of three hours; and towards the morning, he swallowed four dessert spoonfuls of milk, with some caution and address. " At halt past ten o'clock, a. m. (Thursday) his pulse was frequent but tranquil, his animal spirits lively, and he wrote much with a pencil upon paper, concerning various matters. He spoke with effort, and the tone of his voice was still that of a hoarse whisper. Two or three purgative injections brought away a trifling quantity of faecal matter.
At noon, he made a fruitless attempt to swallow. A nutritive injection of milk, and another of broth, were administered in the Course ot" the afternoon and evening. Eight leeches also were applied to his throat. During the night, his pulse became more frequent, and he continued, though rest'ess, to iie on his back only when recumbent. By great, and repeated efforts, he expectorated a piece of hardened mucus besmeared with blood. About two o'clock in the morning, his breathing became greatly embarrassed, his extremities grew cold, and he appeared to be on the point of death. Twelve ounces of blood were withdrawn from his arm; the canula was cleansed and replaced (an operation which was always repeated at short intervals) when to the agreeable surprise of his attendants, his respiration became more easy, the warmth returned to his extremities, his pulse revived, and shortly afterwards his animal spirits and cheerfulness returned. He swallowed a pint of liquid nourishment, at intervals, with tolerable facility ; and he repeatedly expectorated pieces of hardened mucus besmeared with blood. u At ten o'clock, a. ra. on this day (Friday) he appeared -refreshed and amended in all respects. Purgative and nutritive enemata wera administered during the day alternately. He swallowed also small portions of broth and jelly repeatedly. t In the evening, his pulse was 5oft and tranquil, though still frequent. His supine posture was, for the first time, changed to lying 011 his right side. His powers of deglutition were considerably improved, and the tone of his voice greatly amended, He had passed fasces and urine. His tongue, which had hitherto been swollen and hard, was now reduced to little more than the natural size, and was soft and moist; his countenance also was much improved; but he continued to breathe only through the canula. He passed the early part of this night tranquilly, until two or three o'clock in the morning, when his fever increased (similarly to the exacerbation of the preceding night), his breathing became laborious, and he evinced much irritability and despondency of mind. This febrile paroxysm continued for several hours. " At noon on Saturday, his symptoms again wore a favourable appearance, His countenance was natural; his pulse, though frequent, was regular and firm ; his tongue was reduced to its natural size and appearance ; his powers of deglutition were perfectly restored ; and the tone of his voice approached to a low key of the natural sound. HQ had passed copious evacuations, by a sulution of Hochelle salt m chicken* Critical Analysis. chicken-broth. The cannla had been removed from the trachea for some hours; and as he breathed with perfect facility through the natural organs, it was uot afterwards inserted into the aperture. " The evening, and early part of this night, were passed with tranquillity and some sleep. About sunrise, however, he began to shew much impatience, irritability, and alarm. Yet he swallowed, at six o'clock, a. m. on Sunday morning, six or seven spoonfuls of oatmeal porridge, with milk, at his own particular request. About two hours afterwards, his mind appeared to be much disturbed ; his pulse became more frequent and feeble; delirium, and at length stupor supervened, and he sunk rapidly until six o'clock in the afternoon, when he died without a struggle. " At three o'clock on the following day, one of the surgeons who had been in attendance, (and who is a skilful professor of anatomy in this city,) opened the thorax and examined the larynx in my presence. The following is an account of the appearances dictated at the time of the dissection. " On opening the thorax, the cartilages of the ribs proved to be ossified. The left side of the mediastinum, and the surface of the lung contiguous to it, appeared quite dry, as though the parts had been long exposed to air. A similar appearance, though in a less remarkable degree, manifested itself on the right side. The lungs were perfectly sound and natural, excepting a slight adhesion of the right lung to the costal pleura. Somewhat more than half an ounce of aqua pericardii was discovered; the heart itself was perfectly natural. " The membrane common to the larynx and oesophagus, was very much thickened. The epiglottis was perfectly natural; but frora the sides of this, to the arytenoid cartilages, the parts were morbidly thickened, increasing in density, as they approached the cricoid cartilage. The orifice of the rima glottidis was somewhat diminished, but exhibited no appearances of unusual vascularity. On dividing the membranes in the posterior part of the trachea, its internal surface appeared coated with thjn pus, which continued to shew itself to the base of the cricoid cartilage, and between the membrane common to the oesophagus and larynx, and the posterior surface of the cricoid cartilage. Passing a probe into this part, it was discovered that between this membrane and the muscles of the larynx, even to the points of the arytenoid cartilages, was lormed one extensive abscess. " The upper edge of the cricoid cartilage was ossified, and found bare and rough by loss of surface as from exfoliation. The right arytenoid cartilage was dislocated, and when moved on the cricoid, gave the sensation of two bones, stripped of their articulating cartilage, rubbing together. " Tracing the course of the abscess just mentioned, along the right side of the larynx, it was found to extend between the cricoid and thyroid cartilages, until it reached nearly to the edge of the artificial opening made during life, without however communicating Tvith it in any part. " Remarks,?On reviewing the history of the preceding case, the first Medico-ChirurgicaI Transactions. 151 first circumstance of remark is the unexpected suddenness and violence of the morbid affection of the larynx; an affection which has been so ably and discriminately defined by Dr. Farre, in his valuable communications to the Society, that I shall not here enlarge on its diagnostic character. " In the foregoing case, during the course of twelve hours from the first attack (on Tuesday evening) the disease was fully formed. The swelling and erection of the epiglottis; the slow, difficult, and stridulous respiration ; without any pain or oppression of the lung1;, or the slightest erubescence of the visible internal fauces ; the exasperated pulse, and perfect inability of deglutition, marked the disease as cynanche laryngea. " The copious depletion of blood, already detailed, to the amount of 66 ounces, (which was uniformly buffed and closely cupped,) together with the extravasation of 36 leeches, reduced the general fever, without affording any corresponding local relief. It was, at that juncture, a question whether bronciiotomy should be resorted to; and the measure was decided upon, from a consideration of the age and delicate constitution of the patient; and from a persuasion, that time only could reduce the inflammatory tumefaction of the diseased parts. Meanwhile it became essential to facilitate the function of respiration ; and to relieve the bowels, and supply nutriment by the rectum. But the nocturnal exacerbations of fever, (unattended however by any observable rigors,) greatly discouraged the hope of final relief. " On dissection, these phenomena appeared to be accounted for, by the abscess established, and the continual formation of fresh purulent matter. " It was very evident, both from the symploms during life, and from the appearances on dissection, that the inflammatory stage of the disorder had entirely subsided some time previous to the dissolution of the patient. So entirely, in truth, [had the urgent symptoms ceased, that, twenty-four hours before his death, his medical attendants had formed better hopes of the event of his disorder, than they had ventured to indulge at any preceding period. Respiration and deglutition were restored to their natural facility; the fever, though not subdued, had considerably abated ; and the animal spirits, and countenance of the patient, were such as to encourage the hope of ultimate recovery.
In the course of the following night and morning, the febrile exacerbation recurred with more violence and more alarming symptoms lhan ever; delirium, stupor, and at length death supervened, by the process common to febrile exhaustion. " I have already stated, that the patient had a severe attack of a similar, and not improbably of the same disorder, eleven years ago ^ Sir Gilbert Blane has obligingly informed me, that ' he was called to a medical attendance on the subject of this case, in London, in February 1802, when the patient, after labouring under catarrh for ten days, was Seized with fits of strangulation, which continued, at intervals, for a week, during which period he was thrice bled. The blood was buffy, but not cupped, on the two first occasions ; on the third, the buff was absent, and the complaint then assumed a form, so purely 1 spasmodic, 1 152 Critical Analysis? Spasmodic, that opium anrl assafastida were given with evident relief.' I have since been informed, that twenty years ago, whilst he was on a journey in Ireland, he was similarly affected, in so severe a degree, that ?nedical aid was summoned from Dublin on the occasion ; and that a long time elapsed before he recovered from the severity of the di*order. t " On the la>e occasion, the unfortunate resolution which he took, of rising from his bed during profuse perspiration, (excitcd by doses of James's powder,) and of occupying many hours in dictating aloud, conspired at once to expose him to a chill over the surface of his body, and to excite preternatural irritation in the larynx. The predisposition to the specific disorder of cynanche laryngea was not only hereditary, but clearly marked in the individual constitution. " From the foregoing recital, I think, may be inferred, the expediency of resorting early to the operation of bronchotomy, before the lungs are thrown into a disordered condition ; and before the general powers of life are exhausted by the laborious and imperfect exertion of this vital organ. Had not the secret abscess been formed, in the case before us, the general fever would, in all probability, have subsided with the decline of the local inflammation ; whilst the intervening restoration of the powers of breathing and deglutition might have been effectual in preserving the life of the patient." , XVI. Case of Extravasation cf Bile into the Cavity of the Abdomen, from Rupture of the Liver or Call Bladder. By Mr. Fryer, Surgeon, of Stamford. This is an extraordinary case, and the patient appears to have had a narrow escape. The subject of it, a boy aged thirteen, received a violent blow from one of the shafts of a cart, on the region of the liver, which was succeeded by pain, and frequent vomiting of bilious matter. He complained of great sinking, and coldness of the extremities, and his pulse was weak, small, and fluttering. A surgeon was sent for, who ordered the abdomen to be fomented; and, as the patient's stomach rejected every thing, he directed purging clysters to be occasionally thrown up. On the third day, symptoms of inflammation coming on, Mr. Cooper, who we believe was l^Ir. Fryer's partner, was requested to see the child, whom he found then " labouring under considerable pain about the region of the liver; there was great tension of the abdomen, which was extremely sore to the touch, and his vomiting continued as frequent as at first, his stomach rejecting both food and medicine. The pulse was very quick, small, and weak; the skin hot and dry; the tongue much furred ; the urine high-coioured ; and he complained of some difficulty of breathing, and of great thirst." It is verj obvious that w.th such symptoms, after an accident of the nature above described, tiie delay of a very lew hours more would have rendered the only remedy which occurred to Medico-Ghirurgical Transactions. 153 ko us on reading the case, likely to afford relief, ineffectual.
We hardly need mention bleeding, which Mr. Cooper ordered to the extent o? eight ounces. The fomentations were continued, and a few grains of calomel'were ordered to be given every hour tiil proper evacuations, which the glysters had lailed in bringing clown, should be obtained. Afterwards the effervescing mixture, with ten drops of laudanum, every four hours. The following day he was much better, having had some motions; but his sickness still continuing, he was ordered one grain of opium every four hours.
Mr. Cooper saw him again in eight days: the day preceding his visit, the boy had complained of great increase of pain, accompanied by vomiting, which was somewhat relieved by a blister. Mr. C. found him completely jaundiced: his stools were white ; the swelling and tension of the abdomen were much diminished, and the sickness and thirst abated.
The same treatment was continued. Two days afterwards the swelling of the abdomen was increased, and a fluctuation perceptible. In eight days more (twenty-one from the accident) the abdomen was considerabl}-distended with fluid, Tiie patient did not complain of much pain, had the facies Hippocratica, and appeared to be sinking fast. He was now tapped, and thirteen pints of what appeared to be pure bite were evacuated, fie bore the operation well, but did not seem to derive much benefit from it. The operation was repeated in twelve days, and fitteen pints of a similar fluid were drawn off. " He bore the tapping better than before, experienced great relief, and, though he was still much reduced, was evidently better. In nine days more, the tapping was repeated, and thirteen pints of a similar hue evacuated with like advantage." 1 he operation way once more performed after an interval of about nineteen days, when only six pints were drawn off " A purging had come on about a week before. His stools were of a natural colour; "e was much improved in his looks, and his appetite and spirits were good." He continued gaining health and strength, and is now a stout young man.
XVIII. Some Observations on the Use of Opium in Uterine Ji (zmorrhugy. By Mr. Stewart, Lecturer on Midwifery, &c.
The author has detailed two cases to illustrate the utility of opium in uterine haemorrhage. In the first, in which the patient was reduced almost to extremity, in consequence of a month's flooding, the discharge of blood averaging a pint daily, he gave, at seven o'clock, eighty drops of laudanum: no, lag.
x this Critical Analysis. this producing no sensible effect in twenty minutes,-one hundred and twenty drops more were given, which in tea minutes was followed by drowsiness, and a remission of the vomiting and tremors. " At eight o'clock (Mr. Stewart continues) the hand was introduced into the vagina, the os uteri gradually dilated, the placenta detached at one side, the membranes ruptured, and, the hand being carried forward, the child's feet were grasped, and brought into the vagina ; the vomiting and restlessness again recurring, eighty drops of laudanum were given, which produced composure and a permanent cessation of the vomiting, " The fcetus, which appeared to be of the seventh month, was easily extracted. " The hand was introduced immediately afterwards, and the uterus instantly contracted, separating the placenta, and forcing it into the vagina, from whence it was gradually extracted. " At nine o'clock fifty drops of laudanum were given, and at short intervals she took some gruel and brandy. " At ten o'clock I left her, having ordered a draught containing sixty drops of laudanum, to be given at two o'clock next morning.
"At nine o'clock the following morning, I found she had taken lier medicine, had slept two hours, and said she had no complaint; her pulse, which was one hundred and thirty, was very weak, and intermitted. " I ordered her to take fifty drops of laudanum, some beef tea at very short intervals, and occasionally some gruel and brandy. " In the evening she was doing well, and her pulse was the same as in the morning. She took sixty drops of laudanum at bed-time.
" The next day in the morning her pulse was one hundred and twenty, weak and intermitting; she had passed a comfortable night, and felt in every respect easy. She was ordered forty drops of laudanum, and the beef tea, brandy, and gruel, were continued. At night I found her the same as in the morning, and ordered her fifty drops of laudanum at bed-lime. Nauche des Maladies dc la Vessie, Kc, 155 very large doses of it afterwards, with, it appears from the statements before us, beneficial effects.
The author recommends the following rules to be observed where it is thought expedient to administer opium in uterine haemorrhage: " First. Opium ought not to be exhibited, till we have determined that the natural efforts are insufficient to expel the child. " Secondly. When we have determined upon delivering the patient by turning the child, a large opiate, not less than eighty drops of the tincture, or four grains of solid opium, ought always to be given; and, if the circumstances of the case will permit, we should wait twenty minutes if the tincture, or half an hour if the solid opium is given, before the hand is introduced. evidence of preparations, show that it is far from being an uncommon occurrence.
In the treatment, nothing peculiar is recommended by the author distinct from the treatment of stricture of the urethra. Cancer of the Bladder or Urethra.?The author observes that the bladder is seldom originally the seat of cancer, the disease being communicated from the uterus or the rectum.
We have, however, witnessed the complaint in a female, beginning in the bladder and proceeding till it finally destroyed the patient, without either the uterus or the rectum being in the least diseased. The glans penis and extremity of the urethra have not uncommonly been affected with it. There seems to be some confusion in the ideas of the author concerning the nature and origin of cancer in general, in the following passage: " Lorsque le cancer affecte l'uretre, on cherche a remonter a la cause qui Fa determine. Si e'est le vice syphilitique, on administre un traitement approprie; si la maladie est due k une fistule urinaire, on t&che de ia faire cesser.* On administre aussi, k I'interieur, les extraits de cigue, de cynoglosse; on fait des bains locaux avec leurs decoctions, en les unissant aux mucilagineux, pour qu'ils ne soient pas irritans et n'agissant pas comme styptiques, ce que j'ai vu arriver plusieurs fois. L'on retire aussi queiqu' avantage des bains locaux avec les decoctions, ou les sues de douce-amere, de laitue sauvage de morelle. D'autres fois, on n'eprouve de soulagement que des baina locaux mucilagineux et caimans. " Les caustiques partiels sont dangereux; ils ne font que h-^ter la degenerescer.ee cancereuse. Cependant, lorsque la maladie ne fait que commencer, qu'elle n'interesse qu'une petite surface du gland, 1'on peut, selon M. Dubois, en operer la guerison par l'application d'une u&te arsenicale qui detruit avec c6lerite tout la surface affectee. " La maladie occupe-t-elle tout le gland, il faut se lifter d'en faire {'extirpation, avant qu'elle se soit propagee jusqu'& la racine du merobre viril, ou qu'elle ait produit l'engorgement des glandes de Faine, ce qui rendrait I'operation infructueuse. " Pour iaire cette extirpation, on saisit le menibre viril avec Ia main gauche, ayant la pr6caution de retirer les tegumens vers le gland, et Fon retranche la partie malade avec un bistouri. " Apr?s avoir fait la ligature des vaisseaux qui donnent du sang, on introduit une sonde dans la vessie, pour que l'uretre et les corps caverneux ne se retirent pas du c6te du pubis, et que Fouverture du canal ne soit pas oblit?r6e par Ia peau qui se replie sur elle m6me, et par la cicatrisation de Ia plaie.
" Si les corps caverneux, malgr6 la ligature des vaisseaux, fouroissaient trop de sang, on arr?terait Fh6n>orragie au moyen de la " * Voyez des Fistules urinatres," compression Critical Analysis. compression et des styptiques. La plaie doit ensuite 6tre tralt^e ave? un pansement ordinaire." We do not deny that a venereal sore may sometimes become cancerous, unusual as the occurrence is; but, when the author goes on to designate the callosities which surround a urinary fistula by the same name, it will account for the cures of cancer which are often talked of, but which we fear have never taken place where the disease has been of the true carcinomatous structure.
We beg leave to make one more remark on this passage of the author on the amputation of the penis. The use of the sound into the bladder after the operation, we believe is not only unnecessary, but often injurious to the patient.
The chapter on urinary calculi in the bladder and urethra contains many very useful remarks, but, as their utility is more conspicuous than their novelty, we shall not particularly notice them. The smaller species of calculus which is so frequently found in the diseased prostate gland, is well described in the following chapter; and it will be remarked that the opposite lobes of the prostate gland are very differently affected with disease, in the case here described, which, whatever be its cause, we have often remarked in similar cases, one side or lobe often being considerably enlarged, while the other is but little altered.